Individual
DR. TRACI L IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2905 S WALTON BLVD, SUITE 17, BENTONVILLE, AR 72712-6730
(479) 657-6501
(479) 657-6375
Mailing address
2104 S 54TH ST STE 4, ROGERS, AR 72758-8194
(479) 268-4504
(479) 222-0061
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R4023
AR
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
R4023
AR
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
R4023
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117573001
—
AR
Enumeration date
05/01/2006
Last updated
04/18/2024
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